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General NPI Number Information
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NPI Number | 1902116312
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Entity Type | Organization
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Legal Business Name | MENTALLY ILL KIDS IN DISTRESS
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 365 SHORT ST
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-1918
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Country | US
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Telephone | 520-351-9002
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Fax | 602-840-3409
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Provider Business Mailing Address
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Address Line | 7816 N 19TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85021-7036
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Country | US
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Telephone | 602-253-1240
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Fax | 602-253-1250
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Authorized Official
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Title or Position | CEO
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Name | MATT AUNA
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Credential | BHT
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Telephone | 602-253-1240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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